Raising the Dust Chapter Reflections

Chapter 6: Women’s Knowledge, Women’s Work

Last month I described three different ‘categories’ of traditional medicine practice – the spiritual, the herbal, as well as traditional birth attendance. As I mentioned, I have always held a special interest in birth attendance. As a young unmarried mum, I started my nursing training in a large public hospital in order to become a midwife. After I married, I moved away from the city to a more rural location and that is where my nursing and midwifery dreams ended. I kept my strong interests in birth, especially non-medical birth practices alive however, so when I encountered female traditional healers in Malawi, I was keen to speak with them about traditional birth practices.

What I encountered both shocked and re-assured me. Having observed the intimate role that women play in family matters and providing care and support to their communities, I was surprised to hear that at the time of my research, traditional birth attendance had been banned by the government. Needless to say, some of the women who I interviewed did talk about attending to the obstetric needs of the women they treated, and described how they were able to intervene in these situations. It was not something that could be discussed freely, but against the backdrop of my understanding of women’s roles as primary carers, I made the decision to include a number of case narratives on my study.

In order to highlight the position that traditional birth attendants, and other traditional healers find themselves in, under the bans (which were still in force when I returned to Malawi at the end of 2017), I felt that this would be the best way to showcase the conflicts and constraints that people face. Throughout the study I used the first names of all of the interview participants, in order to acknowledge and respect their knowledge and input. yet for the case narratives, I made up names in order to protect the identity of the women who shared their stories.

“Bernice” explained that she had stopped practising as a traditional birth attendant in 2006, when the government bans first came into force. She said she had learned under her mother’s instruction, and via training provided by the Ministry of Health (MoH), prior to the bans. Bernice explained that despite the orders for women to attend a local hospital to give birth, and despite the financial incentives given to the local chief when they do, it was not always possible for this to happen. She said that in these situations, she defies the bans and attends to the expectant mother as a matter of duty. She said she gives the woman the right herbal medicine and “soon [she] will make birth”. Bernice explained “you know we traditional, we Africans, we have still got our rules”. Yet, she stressed that if she suspected there might be any difficulties with the delivery, she would send the woman straight to the hospital, even if she was already in labour. Although she is no longer registered as a traditional birth attendant, she still provides antenatal care for those who request it. Bernice reported that in the four years of her practising as a traditional birth attendant, she had kept detailed birth records and that no mother or baby had lost their lives under her care during this time.

“Rose” became a traditional birth attendant when she was pregnant with her own daughter. Being unable to find anyone to assist with her delivery, she delivered her baby herself and went on to assist other women in giving birth after this experience. Rose has found ways of working within the restrictions and does not reserve her interventions to emergency situation, as Bernice does. Like Bernice however, she also sends women on to the hospital if she encounters difficulties, and even when she delivers a baby without any issues, she still sends the mother on to the hospital afterwards for a check-up. Rose is keeping official records, following on from prior instructions for the MoH. Rose reported that no mother had died whilst under her care, but that two babies had died during delivery, which she attributed to the mother’s poor health.

“Christine” does not consider herself a traditional birth attendant, yet she administers the herbal medicine known to bring on delivery. She said “I am not a birth attendant, but I do give medicine that they can have no difficulty to birth”. She noted that her services were particularly needed in cases where a baby was overdue. It appears that administering this type of medicine is sometimes a part of a herbalist’s general practice, even if they do not consider themselves to be a traditional birth attendant.

“Margret” was in her senior years and had been a traditional birth attendant for many years. At first she asked me why I was asking her about being a birth attendant, when it was all part of the same thing to her. She was a healer and it was just another skill she had developed. Margret was able to explain the tensions and the breakdown in communication between the traditional healers and the MoH and how this had affected traditional birth services. She has a clinic where women can come to give birth and the week prior she had assisted with 5 deliveries at her clinic. She said she generally averages about 8 deliveries each month.  Over the decades of practice, that’s over 1000 births, yet Margret reported that, to date, no mother or baby had died during delivery in her care. There had, however, been two miscarriages.

Margret spoke about some of the challenges facing traditional birth attendants, saying that whilst giving birth is very painful, “and since there is nothing that can reduce that pain, the patient can ill-treat the traditional healer”. If a woman’s pain became too unbearable, or if they became aggressive towards her, despite her extensive skills, she sent them to a hospital. Margret explained that it was routine for traditional healers who assisted with labour to send mothers on to their local hospital for a post-natal check -up and also for vaccinations for their babies, yet they are scorned by the hospitals who say to them “why did you thought it wise to get assisted by a traditional healer? Just go, go back and get vaccinated, get your child vaccinated there, or immunised there” which is an indication they have ill minds, or hearts towards these traditional birth attendants.

The breakdown in co-operation between the traditional healers and the “health professionals” was a source of both sadness and frustration, not only for Margret, but for many of the other healers I interviewed. After these interviews, I spoke with a local researcher about all of this tension. We met as mothers, as fellow researchers and as women. She had conducted in-depth research in the same area where I completed mine. She had stayed with a local traditional birth attendant in this area, for a period of six months. She said she witnessed all of the births the traditional birth attendant had conducted and, contrary to the claimed high morbidity risks associated with home deliveries in the village, not a single mother or baby had died during this time. What’s more, she compared her own hospital delivery with the village births she had witness and said that the women seemed so healthy and strong after having given birth amidst the comforting everyday sounds of the village.

This particular researcher was using her work with traditional birth attendants to try and influence more inclusive birth practices. She had even been shortlisted for USAID funding in support of her research, but had later been excluded from this opportunity, due to the bans on traditional birth attendance practices. This was not stopping her from doing her work, however, instead using the valuable collection of village birth records she had been given, to further her research. Unfortunately, many traditional birth attendants have burnt all their birth records, in protest of the government bans on their practices.

As I mentioned, my encounters with women healers, the female researcher described above, and ordinary women in the villages, about their birth experiences, shocked and dismayed me on some level, yet I was encouraged and inspired too. I was inspired by the resilience of the women I spoke with in the villages about their birth experiences. I was motivated by the researcher I met, as we shared our interests in inclusive birth practices and the challenges facing women giving birth in rural Malawi. I was truly touched by the courage and resilience of those traditional healers and traditional birth attendants I interviewed who, despite the risks, continue to support the women of their communities, according to the traditional knowledge, practices and beliefs they have inherited, most often from other women within their families and their local communities.

Next month, I will present my findings on the importance of community relationships. I will explore some of the tensions between the traditional and biomedical systems and services in my study area and will look at what traditional healers are doing, or trying to do, to overcome some of these tensions and limitations. In the meantime, if you would like any further information about my research, please email me at hippygolucky@hotmail.com

Dr Theresa Jones (PhD) is an intuitive counsellor, incorporating holistic principles and energy healing in her practice, Inner Sense Intuitive Counselling Services. You can contact her on 0458268605